Clinical Features And Stable Period Treatment Of Asthma Patients With Small Airway Obstruction

BackgroundAsthma is a common chronic airway inflammatory disease with an increasing incidence.A variety of genetic and environmental factors together cause reversible airflow limitation.Airway remodeling may occur,causing irreversible airway narrowing,if the inflammation can not be effectively controlled for a long time.Currently,the treatment based on corticosteroids plays a leading role in asthma control.It can act through many processes in the process of airway inflammation to effectively inhibit airway inflammation by inhibiting the accumulation of inflammatory cells such as eosinophils in the airways,inhibiting the formation and release of the inflammatory medium and enhance the ?2 adrenergic receptor reactivity of smooth muscle cells,etc.It has been clinically found that the improvement of small airway function during treatment is closely related to the different modes of administration and the combination of drugs.Effectively identifying the occurrence and progression of small airway inflammation,and taking measures to control airway inflammation,can delay the progression of the disease.ObjectiveTo analyze the clinical features of patients with small airway function impairment in asthma patients.And to evaluate the lung function and FENO test within the patients who have small airway obstruction.So as to provide the reference indications to short-term maintenance treatment of acute exacerbation of asthma patients in clinical,and improve the theoretical support of glucocorticoids in the treatment of asthma with small airway obstruction.MethodsA total of 142 hospitalized patients with acute exacerbation of asthma in the PCCM department of Qianfoshan Hospital of Shandong Province from October 2017 to October 2018 were collected.The entire objectives are accorded with the criterion of 2017 GINA guidelines.All the patients were given anti-inflammatory,anti asthmatic and other treatments for 9-12 days after admission,until the symptoms of acute exacerbation were significantly improved.The pulmonary function indicators and FENO detection were tested.The clinical features of patients with different degrees of small airway injury in asthma patients were compared.Then objectives with small airway obstruction were randomly divided into 3 groups.They receive budesonide aerosol inhalation,budesonide combined with bronchodilator aerosol inhalation,and oral glucocorticoids respectively as the maintained treatment for 4 weeks.The lung function and FENO of the three groups were measured,and the improvement rate was compared to evaluate the clinical efficacy of administration methods and combination of glucocorticoids for small airway obstruction and airway inflammation in asthma patients.Results1.The comparison between the asthma patients with different obstruction degree showed that,the clinical features of gender,age and BMI has no significant differences in the mild small airway obstruction and the severe obstruction patients(P>0.05).Whereas the time interval from onset to regular medication was longer of the severe small airway obstruction patients compared to the mild obstruction group(P<0.05).The course of disease showed no significant difference(P=0.05).2.The baseline data of patients with small airway obstruction showed that there was no significant difference in gender,age,BMI,lung function and FENO between the groups(P>0.05).3.After 4 weeks of maintenance treatment,the FEF 50%,FEF 75%,and MMEF75/25 were significantly increased,and FENO was significantly lower than before(P<0.01).4.The improvement of small airway function and FENO after maintenance treatment was as follows:the improvement of oral glucocorticoids group was the most obvious,followed by budesonide combined with bronchodilator aerosol inhalation,and then,budesonide aerosol inhalation.There were statistical differences between groups(P<0.05).5.The average improvement rate of the lung function of the small airway obstruction was 55%in the oral hormone group,35%in the combined aerosol inhaled group and 19%in the budesonide inhaled group.Conclusion1.The more severe is the obstruction degree of asthma patients,the longer is the time interval from onset to regular medication.It is suggested that early regular drug administration can delay the progression of small airway obstruction in asthma patients.2.The administration after exacerbation treatment still can improve the small airway function and reduce the inflammation of airway.3.Compared to inhalation administration,the systemic glucocorticoids has its advantages on small airway function airway inflammation.In inhalation treatment,glucocorticoids combined with bronchodilator can improve small airway obstruction and reduce airway inflammation more effectively compared with single administration.